Skip to main content
SpringerLink
Log in

Comparing 30-day outcomes between different mesh fixation techniques in minimally invasive inguinal hernia repair

  • Original Article
  • Published:
Hernia Aims and scope Submit manuscript

Abstract

Purpose

The association of postoperative patient-reported outcomes and type of mesh fixation during minimally invasive inguinal hernia repair has not been well characterized. We aimed to compare the 30-day quality of life outcomes between various mesh fixation techniques utilizing the AHSQC prospective registry.

Methods

All minimally invasive inguinal hernias with completed 30-day follow-up were abstracted from the AHSQC, excluding patients with primary indication for surgery being chronic groin pain. Mesh fixation was categorized as (1) atraumatic fixation (AF) (2) traumatic non-suture (TNS), (3) traumatic suture (TS). Our outcomes of interest were pain at site at 30-day and EuraHS quality of life assessment.

Results

After applying inclusion and exclusion criteria, 864 patients had surgical site pain and quality of life outcomes reported; 253 (AF), 451 (TNS), and 160 (TS). After adjusting for identified confounders, there was no statistically significant difference between any fixation method when evaluating pain as a binary variable (Yes/No). However, when looking at the EuraHS evaluation for pain and quality of life outcomes, AF was associated with better scores than both TNS and TS fixation in the cosmetic, restrictions, and overall EuraHS domains. AF was only better than TS fixation in the pain domain.

Conclusion

Our study suggests that AF had a significantly improved hernia-specific quality of life in all domains at 30-days postoperatively. We also identified that pain as a binary variable is inadequate for its states purpose. Thus, the overall well-being and morbidity should be taken into account when evaluating hernia patients postoperatively.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. McCormack K, Scott N, Go P et al (2008) Laparoscopic techniques versus open techniques for repair of a hernia in the groin. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD001785.www.cochranelibrary.com

    Article  Google Scholar 

  2. Köckerling F, Bittner R, Jacob DA et al (2015) TEP versus TAPP: comparison of the perioperative outcome in 17,587 patients with a primary unilateral inguinal hernia. Surg Endosc 29:3750–3760. https://doi.org/10.1007/s00464-015-4150-9

    Article  PubMed  PubMed Central  Google Scholar 

  3. Muysoms F, Campanelli G, Champault GG et al (2012) EuraHS: the development of an international online platform for registration and outcome measurement of ventral abdominal wall hernia repair. Hernia 16:239–50. https://doi.org/10.1007/s10029-012-0912-7

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Lowham AS, Filipi CJ, Fitzgibbons RJ et al (1997) Mechanisms of hernia recurrence after preperitoneal mesh repair: traditional and laparoscopic. Ann Surg. https://doi.org/10.1097/00000658-199704000-00012

    Article  PubMed  PubMed Central  Google Scholar 

  5. Brügger L, Bloesch M, Ipaktchi R et al (2012) Objective hypoesthesia and pain after transabdominal preperitoneal hernioplasty: a prospective, randomized study comparing tissue adhesive versus spiral tacks. Surg Endosc 26:1079–1085. https://doi.org/10.1007/s00464-011-2003-8

    Article  PubMed  Google Scholar 

  6. Stark E, Oestreich K, Wendl K et al (1999) Nerve irritation after laparoscopic hernia repair. Surg Endosc 13:878–881. https://doi.org/10.1007/s004649901124

    Article  CAS  PubMed  Google Scholar 

  7. Prakash PS, Wijerathne S, Salgaonkar HP, Lomanto D (2019) The efficacy of absorbable versus non-absorbable fixation in laparoscopic totally extraperitoneal (tep) repair of large inguinal hernias. Asian J Surg. https://doi.org/10.1016/j.asjsur.2019.01.010

    Article  PubMed  Google Scholar 

  8. HerniaSurge, Group (2018) International guidelines for groin hernia management. Hernia 22:1–165. https://doi.org/10.1007/s10029-017-1668-x

    Article  Google Scholar 

  9. Topart P, Vandenbroucke F, Lozac’h P (2005) Tisseel vs tack staples as mesh fixation in totally extraperitoneal laparoscopic repair of groin hernias: a retrospective analysis. Surg Endosc Other Interv Tech. https://doi.org/10.1007/s00464-004-8812-2

    Article  Google Scholar 

  10. Lovisetto F, Zonta S, Rota E et al (2007) Use of human fibrin glue (Tissucol) versus staples for mesh fixation in laparoscopic transabdominal preperitoneal hernioplasty: a prospective, randomized study. Ann Surg. https://doi.org/10.1097/01.sla.0000245832.59478.c6

    Article  PubMed  PubMed Central  Google Scholar 

  11. Lau H (2005) Fibrin sealant versus mechanical stapling for mesh fixation during endoscopic extraperitoneal inguinal hernioplasty: a randomized prospective trial. Ann Surg. https://doi.org/10.1097/01.sla.0000186440.02977.de

    Article  PubMed  PubMed Central  Google Scholar 

  12. Poulose BK, Roll S, Murphy JW et al (2016) Design and implementation of the Americas Hernia Society Quality Collaborative (AHSQC): improving value in hernia care. Hernia 20:177–189. https://doi.org/10.1007/s10029-016-1477-7

    Article  CAS  PubMed  Google Scholar 

  13. Muysoms FE, Vanlander A, Ceulemans R et al (2016) A prospective, multicenter, observational study on quality of life after laparoscopic inguinal hernia repair with ProGrip laparoscopic, self-fixating mesh according to the European Registry for Abdominal Wall Hernias Quality of Life Instrument. Surg (United States) 160:1344–1357. https://doi.org/10.1016/j.surg.2016.04.026

    Article  Google Scholar 

  14. Tastaldi L, Haskins IN, Perez AJ et al (2017) Single center experience with the modified retromuscular Sugarbaker technique for parastomal hernia repair. Hernia 21:941–949. https://doi.org/10.1007/s10029-017-1644-5

    Article  CAS  PubMed  Google Scholar 

  15. Choi BJ, Jeong WJ, Lee SC (2018) Fibrin glue versus staple mesh fixation in single-port laparoscopic totally extraperitoneal inguinal hernia repair: a propensity score-matched analysis. Int J Surg. https://doi.org/10.1016/j.ijsu.2018.01.029

    Article  PubMed  Google Scholar 

  16. Tolver MA, Rosenberg J, Juul P, Bisgaard T (2013) Randomized clinical trial of fibrin glue versus tacked fixation in laparoscopic groin hernia repair. Surg Endosc 27:2727–2733. https://doi.org/10.1007/s00464-012-2766-6

    Article  PubMed  Google Scholar 

  17. Smith AI, Royston CMS, Sedman PC (1999) Stapled and nonstapled laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair: a prospective randomized trial. Surg Endosc. https://doi.org/10.1007/s004649901104

    Article  PubMed  Google Scholar 

  18. Teng YJ, Pan SM, Liu YL et al (2011) A meta-analysis of randomized controlled trials of fixation versus nonfixation of mesh in laparoscopic total extraperitoneal inguinal hernia repair. Surg Endosc 25:2849–2858. https://doi.org/10.1007/s00464-011-1668-3

    Article  PubMed  Google Scholar 

  19. Antoniou SA, Köhler G, Antoniou GA et al (2016) Meta-analysis of randomized trials comparing nonpenetrating vs mechanical mesh fixation in laparoscopic inguinal hernia repair. Am J Surg 211:239–249.e2. https://doi.org/10.1016/j.amjsurg.2015.06.008

    Article  PubMed  Google Scholar 

  20. Lederhuber H, Stiede F, Axer S, Dahlstrand U (2017) Mesh fixation in endoscopic inguinal hernia repair: evaluation of methodology based on a systematic review of randomised clinical trials. Surg Endosc 31:4370–4381. https://doi.org/10.1007/s00464-017-5509-x

    Article  PubMed  Google Scholar 

  21. Olmi S, Scaini A, Erba L et al (2007) Quantification of pain in laparoscopic transabdominal preperitoneal (TAPP) inguinal hernioplasty identifies marked differences between prosthesis fixation systems. Surgery 142:40–46. https://doi.org/10.1016/j.surg.2007.02.013

    Article  PubMed  Google Scholar 

  22. Wright JG (1999) Outcomes research: What to measure. World J Surg 23:1224–1226. https://doi.org/10.1007/s002689900652

    Article  CAS  PubMed  Google Scholar 

  23. Loos MJA, Houterman S, Scheltinga MRM, Roumen RMH (2008) Evaluating postherniorrhaphy groin pain: visual analogue or verbal rating scale? Hernia 12:147–151. https://doi.org/10.1007/s10029-007-0301-9

    Article  CAS  PubMed  Google Scholar 

  24. Bowley DMG, Butler M, Shaw S, Kingsnorth AN (2003) Dispositional pessimism predicts delayed return to normal activities after inguinal hernia operation. Surgery 133:141–146. https://doi.org/10.1067/msy.2003.34

    Article  PubMed  Google Scholar 

  25. Tam K-W, Lang H-H, Chai C-Y (2010) Outcomes of staple fixation of mesh versus nonfixation in laparoscopic total extraperitoneal inguinal repair: a meta-analysis of randomized controlled trials. World J Surg 34:3065–3074. https://doi.org/10.1007/s00268-010-0760-5

    Article  PubMed  Google Scholar 

  26. Sajid MS, Ladwa N, Kalra L et al (2013) A meta-analysis examining the use of tacker mesh fixation versus glue mesh fixation in laparoscopic inguinal hernia repair. Am J Surg 206:103–111. https://doi.org/10.1016/j.amjsurg.2012.09.003

    Article  PubMed  Google Scholar 

  27. Taylor RS, Ullrich K, Regan S et al (2013) The impact of early post-operative pain on health-related quality of life. Pain Pract 13:515–523. https://doi.org/10.1111/papr.12026

    Article  PubMed  Google Scholar 

  28. Ip HYV, Abrishami A, Peng PWH et al (2009) Predictors of postoperative pain and analgesic consumption. Anesthesiology 111:657–677. https://doi.org/10.1097/aln.0b013e3181aae87a

    Article  PubMed  Google Scholar 

  29. Van Boekel RLM, Vissers KCP, Van Der Sande R et al (2017) Moving beyond pain scores: multidimensional pain assessment is essential for adequate pain management after surgery. PLoS ONE One 12:1–16. https://doi.org/10.1371/journal.pone.0177345

    Article  CAS  Google Scholar 

Download references

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Comprehensive Hernia Center, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA

    S. Tish, D. Krpata, R. AlMarzooqi, A. Fafaj, L. Tastaldi, H. Alkhatib, S. Zolin, C. Petro, M. Rosen & A. Prabhu

  2. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA

    L.-C. Huang & S. Phillips

  3. Department of General Surgery, Washington University in Saint Louis, 1 Barnes Jewish Hospital Plaza, St. Louis, MO, 63110, USA

    S. Tish

Authors
  1. S. Tish
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. Krpata
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. AlMarzooqi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. L.-C. Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S. Phillips
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A. Fafaj
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. L. Tastaldi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. H. Alkhatib
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. S. Zolin
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. C. Petro
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. M. Rosen
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. A. Prabhu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. Tish.

Ethics declarations

Conflict of interest

Author MR reports receiving salary support for role as medical director of the non-profit AHSQC, relevant to the work, as well as board membership of Ariste Medical and grants to the Cleveland Clinic Institution from Intuitive, Pacira, and Miromatrix, outside the submitted work. Author AP reports grants to the Cleveland Clinic Institution from Intuitive, and personal fees from MedTronic and Bard Davol, outside the submitted work. Author DK reports educational grants to the Cleveland Clinic Institution, outside of the submitted work. Authors LC and SP report that the AHSQC has contracted with Vanderbilt Biostatistics to provide support for AHSQC projects and the work provided was performed under the umbrella of the AHSQC-Vanderbilt Biostatistics collaboration plan, relevant to the work. Authors LT and AF report resident research grants from the AHSQC, outside the submitted work. All other authors declare that they have no conflict of interest.

Ethical approval

All procedures related to this study were compliant with current US law. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Human and animal rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

The project only involved analysis of exisitng de-identified data, informed concent was waived.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tish, S., Krpata, D., AlMarzooqi, R. et al. Comparing 30-day outcomes between different mesh fixation techniques in minimally invasive inguinal hernia repair. Hernia 24, 961–968 (2020). https://doi.org/10.1007/s10029-020-02123-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10029-020-02123-8

Keywords

Search

Navigation